Also you might want to check out thishttp://www.hp.com/aquarius/HP_Health&Life_Science_SymposiumV/Keynote/Paul_Sharek.pdf
This is also a very good reference to read , slides numbers 2-6 are related to the doctors with guns analogy but the rest is a well written treatise on patient safety which is the whole point of me writing the latest Airway slideset, as a followup to my Occasional intubator presentation on YouTube here

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6 years ago

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Ben Hoffman

Great points Minh, I think most ambos would probably fit into the category of the occasional intubator. There was some discussion of the MAS Paramedic RSI trial here in NZ and conclusions made that the cardiac arrests were likely due to the large dosages of fentanyl and midazolam. Intensive Care Paramedic RSI on this side of the ditch uses fentanyl 0.5mg/kg and ketamine 1.5mg/kg for patients who have significant shock.

Thiopentone is nasty horrid yellow powered drack that should be binned forever and never see the light of day again. Ketamine is the absolute best thing ever, I love it to bits but must disclaim it produces the most bizzare effects I have ever seen. Oh well thats “disassociation” for you!

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6 years ago

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Don Diakow

Minh. Great review again……….had a medical director here say that folks that die in the ER post an Airway procedure had a Benzo just prior. Amazes me how hypotensive patients will still get midazolam by some practitioners.
Hey was that your son in one of the first slides trying to get a view of the cords on the intubation mannequin?

not sure where your med director was going with that comment. very little hemodynamic effects from midazolam.

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6 years ago

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Don Diakow

Thank you Dr. Weingart for the comment from your vast experience. I can only guess that it was the combo of Fentanyl 2 mcg/kg with Midazolam 0.1/kg and then Succs in the hemodynamically compromised trauma patient..
We have switched to Ketamine/ Succs in these subset of patients.

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6 years ago

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Minh Le Cong

Hi DOn
yes thats my son using the Airtraq on the mannikin during one of my airway courses. Thought he should start learning early. Kids these days are already pretty good with video game hand eye skills. Nintendo Wii could have a difficult airway intubation game on it to practice techniques like awake fibreoptic flexible scope intubation or video laryngoscopy…now theres an idea!
Midazolam if y bolus a large dose it can cause hypotension. I have definitely witnessed that. The way I and I assume Scott uses midazolam, if titrated, it does not cause haemodynamic issues in general, Jimmy D talks about using 0.5mg doses at a time in the unstable patient